Provider Demographics
NPI:1528211414
Name:BEVLYN SAGON PHD LLC
Entity Type:Organization
Organization Name:BEVLYN SAGON PHD LLC
Other - Org Name:SAGON AND ASSOCIATES PSYCHOLOGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-447-1167
Mailing Address - Street 1:1700 N DIXIE HWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432
Mailing Address - Country:US
Mailing Address - Phone:561-447-1167
Mailing Address - Fax:561-447-1164
Practice Address - Street 1:1700 N. DIXIE HWY
Practice Address - Street 2:SUITE 150
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432
Practice Address - Country:US
Practice Address - Phone:561-447-1167
Practice Address - Fax:561-447-1164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7653251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health